Sloan-Kettering, M.D. Anderson and Johns Hopkins (three of the top CCCs) almost always treat base-of-tongue cancers with chemoradiation and do not do up-front surgery because of the potentially serious impacts on swallowing and speech. However, at least at Hopkins, cancers in the oral tongue may be treated with surgery first if this can be done without major damage; if not, then they do chemoradiation. At some centers brachytherapy is done in the tongue (radioactive seed implants) -- Beth Israel in NYC and also, I think, Sloan will do this.

In never-smokers a certain proportion of tonsil/base-of-tongue cancers are human papilloma virus-16 induced and these have a much better prognosis than those caused by smoking or other environmental carcinogens (Gillison's 2000 paper said 59% better survival and she told us last Friday that this difference is holding up in her subsequent research.). This difference appears independent of cancer stage or nodal involvement (!), age and gender of patient, a very important point. While initial recommended treatment is the same (chemoradiation), the risk of recurrence after treatment is fairly low. There is a HPV vaccine entering clinical trial which may prove to have a role in treating HPV+ tumors in some future year (but not now).

Gail

Husband Barry DX 6/21/05 Stage IV SCC right tonsil, BOT, 2 lymph nodes, tonsillectomy, 33 treatments radiation (Tomo-Therapy ) plus 7 weekly doses carboplatin, treatment completed 9/29/05 at Johns Hopkins.